Lisa Shettle, RDN CDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

001685 Issued in CT

Practice address

65 Kelsey LN
Glastonbury, CT 06033-5040

Phone

(860) 916-2486

NPI assigned

Nov 30, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optimal Nutrition LLC

  • Health Service Clinic/Center
  • Glastonbury, CT
  • NPI 1073086203
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543536000000",
    "number": "1740750835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 KELSEY LN",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060335040",
            "telephone_number": "860-916-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 KELSEY LN",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060335040",
            "telephone_number": "860-916-2486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETTLE",
        "first_name": "LISA",
        "credential": "RDN CDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-30",
        "last_updated": "2018-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "001685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mun Yi Shea, PHD
• Persa Shehreen
• Shanta Shepherd, M.D,
• Lorin Sher, DMD, PHD
• Sheryll Waring LPC Ladc LLC
• Kathleen Ann Shimwell, LCSW
• Tracy Sibley
• Alisa Sue Siegfeld, M.D.
• Jessica Marie Siervo
• Laura R Sievering, PA-C

• Registered Dietitian in Glastonbury, CT
• Providers in Glastonbury, CT by specialty
• Registered Dietitian in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.